Maintaining Target Hemoglobin A1c Less than 6% May Increase Mortality in Patients with Type 2 Diabetes

Type 2 diabetes
affects around 8% of the US population. Patients with type 2 diabetes have high blood sugar that leads to many cardiovascular problems. One measure of the disease is a blood test performed every three months that measures the hemoglobin A1c. It is an estimate of the average blood sugar level over the three month time. One goal in treating diabetes has been to maintain the HAIc at a level less than 7%. Recent studies have been conducted to assess the benefit of a HAIc level less than 6%.

Two recent studies are inconsistent in their results. The ACCORD trial was stopped early because higher mortality (death) was found in the group who had maintained the HAIC less than 6%.The ADVANCE trial showed no increase in mortality. Both of these studies are unpublished.

About the Study

The Action to control Cardiovascular Risk in Diabetes (
ACCORD
) trial evaluated 10,251 adults with type 2 diabetes. The participants were aged 40-82 years and had 2 or more other cardiovascular risk factors. Patients were randomly assigned to one of two groups.

One group received Intensive blood glucose-lowering treatment with target hemoglobin A1c (HbA1c) less than 6%.

The second received standard blood glucose lowering-treatment with target HbA1c 7-7.9%.

In the Action in Diabetes and Vascular Disease (
ADVANCE
) trial evaluated 11,140 patients with type 2 diabetes. Participants were randomly assigned to one of two groups.

One group received intensive glucose lowering using modified-release gliclazide (Diamicron MR).

The second group received standard guidelines-based glucose lowering.

In the ACCORD trial most patients in the intensive treatment group required combinations of diabetes medications. The intensive glucose-lowering portion of the study was stopped early due to slightly higher rate of death.

The ADVANCE trial showed no evidence of increased mortality with intensive glucose-lowering.

In general, patients in the ADVANCE trial had less severe disease than those in ACCORD.

How Does This Affect You?

There are many medications used to treat diabetes. Blood sugar control is vital to feeling well and avoiding complications of diabetes. The two research studies question the amount of blood glucose control patients should achieve. Always discuss your healthcare goals and medication changes with your physician. Remember, diet and exercise are still important parts of diabetes health.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Major international diabetes study does not confirm increased risk of death reported by US trial [press release]. The George Institute for International Health; Feb 13, 2008. Available at:
http://www.advance-trial.com/static/html/virtual/contents.asp?P=39
.